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T FOR OFFICE USE: I FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No.7. �: -�� <br /> -------------------- <br /> IComplete in Triplicate) <br /> --------------------------- -- ......... Date Issued.!—f/,cP-.2f <br /> „•................................._*:........._......;...., _� rThis Permit Expires l#Year From Date Issued""" "� y <br /> Application is hereby made to the San Joaquin Local Health District for a permit tglconstruct,and.instal I the work herein described, <br /> This application is made in compliance with County Ordin ce No. 549 and existing Rules and Regulations: <br /> JOB AD ------ CENSUS TRACT:......_ --- <br /> PRESS/LOCA;TIOl' �'V .c►�"o`'a-.`-r <br /> .. k -.//.. <br /> r _Phond7 <br /> . � <br /> Owner's Name..............:.. _... <br /> �.......ziGtY <br /> .Address <br /> .-�.I <br /> Contractors Name..-- .......'-..... ----.License # 11�. 1---- .Phone.- `- ..--- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> !Motel ❑ Other.... ... -- _� a ..-..��..•.. .�.�� - .: <br /> I A }� <br /> Q-- - --- <br /> Number of living units:---...-"-,..-__Number of bedrooms..:.Garbage'Grinder............1o) Size......... . <br /> '�`:-1. Private ❑ <br /> Water Supply: Public System and name.. ... .-.- -- --- ------- <br /> Character of soil to a depth of 3 feet:—. .Sand ❑- Silt.0 Clay ❑ Peat_❑_._.Sandy Loom ❑ Clay Loam [I <br /> Hardpan I] Adobe Fill Material.. __.. - -.If yes, type <br />► (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />` NEW INSTALLATION: [No septic tank or seepage pit permitted if public sewer is available within 200 feet,) O <br /> . <br /> \ Luth-- ---- <br /> l PACKAGE TREATMENT [ } SEPTIC.TANK [ ] `� ..Size ... ... --:-. ---_•=------�-----------•----- --.M--��-�- iid De ---------------- <br /> q P <br /> _ No. Co artments_....----•-------------•""'---- �- <br /> Capacity------ ----------- TYPe-----. _ ---- _... Materia) -------------- -------- p <br /> f Foundation... ;..._... Prop. Line ,'" <br /> i Distance to nearest: Well ... <br /> 1 . <br /> LEACHING LINE [ ] No. of Lines - -------------- ...Length of each line.=------'---•.-..-•---• Total Length .....-..... --...---- ...... ........ <br /> i ::. <br /> 'D' Box__ .......Type Filter Material....... ..... .... Depth Filter Material_ ---..----.---------- <br /> hPro ...----.-•---.............. <br /> Distance to nearest:.Well---------------------- --"--.Foundation------ '---------- Property Line <br /> .v._ n=..., . <br /> i Rock Filled Yes ❑ No <br /> SEEPAGE PIT [ ] Depth---------- ----Diameter..-----------_...---.Number..----.---.---------- <br /> a. <br /> �"L. .: _ . `.... Rock Size._.-. <br /> Water Table Depth. ---- --- ----- - - <br /> .... <br /> r , <br /> Distance to nearest: Well._ -------�:- ---�--� ��-----. "------Foundation--------- ---- ..._....._.Prop. Line__.......'- --- ------ <br /> Distance <br /> ` s <br /> i` _ . .":.. `---.......Date.-------:------ " ............... ) <br /> REPAIR/ADDITION (Prev. Sanitation Permit#- --- --------- "--'-"' <br /> ` Septic Tank (Specify Requirementsl......... ........ . ... '. .... ----------- - - -..-.. <br /> 1;' c-! <br /> y Disposal Field [Specify Requirements)-.....(,X..c�` fiC./ ' --..f2(f- L=L' <br /> - - -- --- - KLA <br /> I........... <br /> --------------­......... <br /> .� <br /> ------ ------------ ......... ------- <br /> --'-...Y... -- <br /> ................ ---------- <br /> ------- <br /> ,, - " ............... <br /> ............... ......_ <br /> ....... ....... ......� ­­­1-`------ --' <br /> -----------­­...........I...............I........ <br /> (Draw existing and required addition on reverse side),_ <br /> I hereby certify that 1 have prepared this application and that the work will be' done"in"accordance with .San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Di�strrict• Home owner or:licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, ],shall not employ any person m such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> i <br /> Owner <br /> f <br /> Signed..-,. ��- ---�� '- - - �� -�- �- - . ...-----�� - ..... --. -~-.---- -. .- ---... - .. <br /> ! ..--- <br /> - -------- --- '- <br /> -- -- M--'Title.- <br /> ( ther than owner[ <br /> OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ . � <br /> `� _.::....��_ : _...-...... � ..-,... <br /> -- ... -DAT!=.. ---� ........ -- -- - <br /> DIVISION OF LAND NUMBER.- ... - ._. -. <br /> ADDITIONAL COMMENTS...------------............r <br /> z <br /> . .. <br /> ;eN <br /> ---•------- . '-.. - ------------------ --- ------ ----- <br /> D <br /> .............. + <br /> Date. <br /> Final Inspection b <br /> F&5 21677 RFV.7/76 <br /> fK 13 24 JOAQUIN LOCAL HEALTH DISTRICT <br />